Clinical Specialist - (Prefer Nurse + CRC Coder)

Our Client is seeking a Clinical Specialist - Coder that can support clients transitioning to value-based programs and troubleshoots lagging performance by assisting in removing barriers. The Clinical Specialist is a nurse and certified risk adjustment coder. They serve as an advisor and consultant on coding initiatives for internal and external stakeholders.  This individual will create and review clinical content related to coding, perform coding audits for select clients, and train clients on accurate and complete coding. 

Job Responsibilities: To perform this job successfully, an individual must be able to perform the following satisfactorily; other duties may be assigned. 

• Audit accuracy, quality, and consistency of coded data by conducting audits of medical records, practice management systems, billing systems, and computer databases related to Medicare reimbursement.
• Serve as a subject matter expert on topics such as CMS risk adjustment coding, Hierarchical Condition Category (HCC) coding, best practices, and medical record review criteria.
• Train and facilitate educational events related to best practices in coding for audiences, including primary care physicians, nursing staff, administrators, coders, and billers. 
• Coordinate with Delivery Team, Content Team & Product Team to develop, integrate, and maintain clinical coding content into our Approved Content library and Platform product functionality.
• Verify compliance with federal, state, and local laws, especially regarding Medicare coding and documentation guidelines. Synthesize complex information from multiple, sometimes conflicting, sources to form a conclusion. 
• Education content inquiries and provide training for internal and external staff.

Requirements

• Proficient and knowledgeable in ICD-10, CPT, HCPCS, and HCC Coding.
• Demonstrates ability to provide training on documentation & coding in a way that engages multiple learners (physicians, nurses, medical assistants, practice administrators, office staff).
• The ability to evaluate medical records with attention to detail and to summarize findings.
• Excels in public speaking and client engagement.
• Ability to collaborate and meet demands.
• Proficient planning and organizational skills.
• Calm and effective in a high-pressure, fast-paced, client-driven environment.
• Self-motivated and able to work independently and collaborate in a virtual environment while managing multiple deliverables with competing priorities. 

Qualifications

• LPN or RN or equivalent degree.
• Certified Coder credentials (CPC, CCS) CRC certification preferred.
• Experienced working with ACO- Accountable Care Organizations.